Up to 80% of Singaporeans experience low back pain at some point of their lives, but most cases are not serious or life-threatening. Find out more about the common risk factors, when to consult a doctor and lifestyle changes to manage low back pain.

Introduction

• Up to 80% of people in Singapore experience Low Back Pain at some point in their lives.
• Most cases are not serious or life-threatening. The vast majority improve or recover in about 6 weeks with self-management without needing to see a doctor.

Other possible symptoms 

As Low Back Pain is a symptom and not a medical diagnosis, these are other symptoms that you may feel with Low Back Pain:

• Back stiffness and soreness
• Pain worsens with coughing or sneezing
• Weakness, numbness or tingling down legs 

Common risk factors

• Sitting, standing or bending for a long time
• Sedentary lifestyle
• Overweight
• Repetitive activity (e.g. frequent heavy lifting)

When should you consult a doctor? 

Consult a doctor urgently if you are experiencing any of the following:

• Change in urinary and bowel control
• Numbness or tingling sensation over your legs or private region

Consult a doctor early if you are experiencing any of the following:

• Unexplained weight loss
• Persistent pain from an injury
• Fever or night sweat
• Pain which does not improve after rest or pain medication
• Swelling, redness or severe pain affecting multiple joints
• Any loss of function (e.g. Unsteady walking, weakness, worsening balance)

How long does recovery take?

• Most Low Back Pain recover in a few weeks with self-management. For some, it may recur over time
• These can help you return to your regular activities
  • Understand your pain
  • Make appropriate lifestyle changes
  • Set right goals
• Certain Low Back Pain may persist and require regular management (e.g. back strengthening exercises)

Lifestyle changes to prevent / manage Low Back Pain

• Refer to leaflet on “Self-help tips to manage pain”.
• If getting out of bed is difficult, try turning your body to the side and you may use your arms to lift your body up into a sitting position.
• Carry things close to your body when lifting them.
• Exercise can help to relieve LBP¹. You may start with simple aerobic exercises, such as walking or aqua aerobics, to improve movement and function. Your pain should not get worse with exercise.
• Do self-directed stretches and exercises regularly.

Self-directed stretches and exercise

Frequently Asked Questions

“Should I rest in bed the whole day when I have Low Back Pain?”

• No. Complete rest in bed is not recommended. When you avoid movement, your body generally becomes weaker. Some gentle activities can help in your recovery.

“Can I exercise if I was told that I have degeneration/wear and tear in my back?”

• Getting older does not directly cause Low Back Pain. Degeneration or wear and tear are common age-related changes. But research shows that these are not strongly related to Low Back Pain².
• Exercise will not worsen the degeneration/wear and tear. In fact, it will help to strengthen your muscles and protect your joints better!

“Do I need any imaging?”

• Most back pain does not need imaging as changes related to wear and tear are commonly seen and are not always the cause of pain².
• X-ray findings often do not fully explain back symptoms, and may cause unnecessary fear and anxiety.
• If your back pain persists or presents with other symptoms, your doctor may advise further imaging such as X-Rays, CT scans or MRI.

“Do I need a specialist?”

• Most cases of Low Back Pain do not need specialist treatment. Injections, surgery, and strong medications do not usually cure long term Low Back Pain.
• Your doctor will only refer you to a specialist, e.g., an orthopaedic surgeon if necessary.

“Is it true that I have to sit straight to prevent any Low Back Pain?”

• No. It is a myth that a “straight and upright” posture is the best. There is no single best posture to prevent Low Back Pain.

“My back is often sore at the end of a day’s work. How can I prevent this?”

• You may need to modify your activities or work environment. It is often how the person performs a certain activity that results in unnecessary stress to the back, causing soreness. Specific instructions on how to modify activity or work environment can be provided by a doctor or therapist.

Disclaimer

In most cases, your pain should improve in 6 weeks. See a doctor if your pain worsens or if you have any of the symptoms stated in the “When should you consult a doctor” section above.

Support networks / Useful links

• NHS Ayrshire and Arran low back management https://www.nhsaaa.net/musculoskeletal-service-msk/low-back-pain/low-back-pain/
• NHS University Hospital Coventry and Warwickshire https://www.uhcw.nhs.uk/self-care/
• Active Health Homepage (activesgcircle.gov.sg)

Acknowledgements

One-Rehab Musculoskeletal Workgroup (Jan 2023 - Dec 2023)

Musculoskeletal Physiotherapists from Public Healthcare Institutions 

References

1. Rahman Shiri, David Coggon, Kobra Falah-Hassani, Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials, American Journal of Epidemiology, Volume 187, Issue 5, May 2018, Pages 1093-1101, http://doi.org/10.1093/aje/kwx337 
2. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B.W. Chen, L.E. Deyo,R.A,., …& Jarvik, J.G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology, 36(4), 811-816.